Follow the steps to fill out the form with ease

1. Click the ‘Get Form’ button to obtain the form and access it in the editor.
2. Begin by entering the contract number in the designated field, ensuring accuracy to avoid future issues.
3. Fill in the owner's name and, if applicable, the joint owner's name in the corresponding fields.
4. Provide the owner's and joint owner's Social Security Number (SSN) or Tax Identification Number (TIN) as requested.
5. Input the telephone numbers for both the owner and joint owner to ensure proper communication.
6. Select either 'Partial Withdrawal' or 'Full Contract Surrender.' If choosing a partial withdrawal, indicate whether it is a gross withdrawal or net check amount, and specify any penalty-free amounts as applicable.
7. If applicable, complete the 'Tax Withholding Election' section to indicate if you want federal and/or state taxes withheld from your distribution.
8. For the ‘Account Election for Distributions’ section, specify which account(s) the withdrawal should be taken from, if preferred.
9. Read and complete the certification section, ensuring all details are correct to avoid penalties.
10. Sign and date the form at the 'Signature and Authorization' section. If applicable, ensure that any joint owner or spouse also provides their signature.
11. Finally, review all entered information for accuracy before submitting. You can save your changes, or print and share the completed form as necessary.

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